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NPI Code Detail

MEDICARE: DR. TRAVIS ROBERT DAVIS DMD

MEDICARE: DR. TRAVIS ROBERT DAVIS DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDE60776469WA

General Provider Information

NPI Number : 1033649561
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TRAVIS ROBERT DAVIS DMD
Provider Business Mailing Address
First Line : 14910 SE WOODLAND WAY
Second Line :
City : MILWAUKIE
State : OR
Zip : 97267-2743
Country : US
Telephone Number : 971-645-8068
Fax Number :
Provider Business Practice Location Address
First Line : 4309 W NOB HILL BLVD
Second Line :
City : YAKIMA
State : WA
Zip : 98908-3971
Country : US
Telephone Number : 509-823-4480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2017
Last Update Date : 07/26/2017

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